Provider Demographics
NPI:1023116548
Name:INTELI-CARE, LLC
Entity type:Organization
Organization Name:INTELI-CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ONESIMO
Authorized Official - Middle Name:C
Authorized Official - Last Name:VIGIL
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MBA
Authorized Official - Phone:505-898-9745
Mailing Address - Street 1:2116 VISTA OESTE NW STE 102
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4340
Mailing Address - Country:US
Mailing Address - Phone:505-898-9745
Mailing Address - Fax:505-884-8667
Practice Address - Street 1:2116 VISTA OESTE NW STE 102
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-4340
Practice Address - Country:US
Practice Address - Phone:505-898-9745
Practice Address - Fax:505-884-8667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM06274081Medicaid
NM85277304Medicaid
AZ820408Medicaid
NM63430061Medicaid